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98 Cards in this Set
- Front
- Back
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How long do panic disorders last?
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typically lasting 15- 30 minutes
- pretty short, not too long - COMES ON SUDDENLY |
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What are the s/s of panic disorder?
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* 4 or more of the following symptoms (Like a heart attack)
- fear of dying - sweating , dizziness - chills or hot flashes - Palpitations , TACHYCARDIA - SOB - CHOKING or SMOTHERING SENSATION - CHEST PAIN - NAUSEA -FEELINGS OF DEPERSONALIZATION |
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What do we screen all anxiety patients for?
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SUBSTANCE ABUSE
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What two thing should you teach a patient with panic disorder?
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IDENTIFY:
1) their TRIGGERS 2) their RECOGNIZE S/S * so they know when they are experiencing an attack |
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What phobia can a patient with panic disorder experience?
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AGORAPHOBIA , due to a fear of being in places where previous panic attacks occurred
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Give examples of Agoraphobia
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ex. If previous attacks occurred while driving, client may stop driving
ex. if attacks continue while walking or taking alternative transportation , client may stay at home |
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Define Agoraphobia
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the client avoids being outside and has impaired ability to work or perform duties
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What drug is most used for panic disorder?
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Benzodiazepine (quick acting) calms anxiety
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What is xenophobia?
What is claustrophobia? |
- xenophobia = FEAR OF STRANGERS
- claustrophobia = FEAR OF ENCLOSED SPACES |
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What is the definition of Obsessions?
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Irrational thoughts, unwanted ideas or impulses that occur repeatedly in the person's mind
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What is compulsion?
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Acts (physical or mental) repetitive rituals that individuals perform to lessen anxiety and temporarily make them feel better
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What is Obsessive- Compulsive Disorder?
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* Client has intrusive thoughts of unrealistic obsessions and tries to control these thoughts with compulsive behaviors such as repetitive cleaning or washing hands
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If rituals include handing washing or clean skin , with OCD, what two things can occur?
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SKIN DAMAGE AND INFECTION MAY OCCUR IF BEHAVIORS DO NOT DECREASE
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Client engages in constant ritualistic behaviors may have difficulty in meeting what?
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SELF- CARE
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What is goal for nurse , to do with an OCD pt?
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REDUCE THEIR BEHAVIOR
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What clients are most likely to be members of OCD SUPPORT GROUP?
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- A 30 yr old who performs handwashing 5 times a day
- A 35 yr old who wears gloves when touching a public faucet - A 50 yr old who cannot throw anything away - A 60 yr old who repeatedly locks on locked doors |
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What is Generalized Anxiety disorder?
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- more then 6 months of uncontrollable excessive worry
AKA CHRONIC CONDITION |
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S/S of GAD
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* at least 3 physical s/s
- FATIGUE - RESTLESSNESS - PROBLEMS W/ CONCENTRATION - IRRITABILITY - INCREASED MUSCLE TENSION - SLEEP DISTURBANCE |
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What does GAD cause?
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CAUSES SIGNIFCANT IMPAIRMENT IN 1 OR MORE AREAS OF FUNCTIONING SUCH AS WORK RELATED DUTIES
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What is Acute Stress Disorder?
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- Exposure to traumatic event causes NUMBING, DETACHMENT, AND AMNESIA ABOUT THE EVENT
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When do symptoms occur for ACUTE STRESS DISODER?
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- 1st Symptoms occur within 4 weeks
- first symptoms occur within 4 weeks , symptoms last from 2 days to 4 weeks |
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IN ACUTE STRESS DISORDER they have a persistent re-experience in distress when:
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- REMINDED OF EVENT
- DREAMS OR IMAGES - FLASHBACKS |
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What are s/s of Acute stress disorder?
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- AMNESIA
- ABSENT EMOTIONAL RESPONSE -DECREASED AWARENESS OF SURROUNDINGS - depersonalization - severe anxiety |
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What is Post Traumatic stress disorder?
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- Exposure to traumatic event causes intense fear, horror, flashbacks, feelings of detachment. forboding, restricted affect, and impairment
- CHRONIC DISORDER |
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What is ONSET of PTSD?
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- onset of symptoms is delayed at least 3 months and last > 1 month
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PTSD have persistent re-experience in?
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- recurrent , intrusive recollection of event, dreams, images and reliving through flashbacks
- ILLUSIONS - HALLUCINATIONS |
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S/S of PTSD?
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- IRRITABILITY
- POOR CONCENTRATION - SLEEP DISTURBANCE (night mares) - AVOIDING PEOPLE - INABILITY TO SHOW FEELINGS |
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Nursing Interventions for anxiety
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- Provide safety and comfort to client during crisis period
- REMAIN WITH CLIENT DURING THE WORST OF ANXIETY TO PROVIDE REASSURANCE - Sit and talk to client using therapeutic communication skills to help client express feelings of anxiety - use relaxation techniques with client as needed for symptoms of pain, muscle tension and feelings of anxiety |
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What should you teach patients with anxiety disorders?
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- teach the client about prescribed meds for anxiety as needed
- teach client to identify when anxiety Is happening |
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When the anxiety has passed, help the client evaluate what?
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- coping mechanisms that work and do not work for controlling anxiety
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Should you do health teaching while client is anxious?
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no, do it until after acute anxiety subsides
* Especially clients with panic attacks or severe anxiety are unable to concentrate or learn |
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Enhance self-esteem of a patient with anxiety how?
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- by encouraging positive statements and discussion of past achievements
*instill hope for positive outcomes but avoid false reassurance |
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Advanced Practice nurses may be trained in other therapies to tx anxiety disorder, such as?
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- COGNITIVE BEHAVIORAL THERAPY
- BEHAVIORAL THERAPY - GROUP THERAPY (for clients with PTSD) |
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What are somatoform disorders?
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Psychiatric conditions in which the physical symptoms that the client is experiencing cannot be fully explained by a medical problem or another psychiatric disorder
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What are some examples , difficult for a clinician to differentiate a somatoform disorder from a medical condition?
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- Cerebrovascular Accident (CVA)
- stroke and brain attack - encephalopathy - drug and alcohol abuse - multiple sclerosis |
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Somatoform disorders may be challenging , because the client does what?
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- They demand certain treatment or diagnostic procedures
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What is Hypochondriasis?
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- A preoccupation with bodily functions and fears of acquiring or having a serious disease based on misinterpretation of physical symptoms
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What is conversion disorder?
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- sudden loss of neurological function, usually at a time of severe stress that cannot be explained fully by physical disorder
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In conversion disorder, the onset of symptom is usually linked to what?
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socially or psychologically stressful event
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S/S OF CONVERSION DISORDER
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- INABILITY TO WALK
- WEAKENESS - IMPAIRED COORDINATION OR BALANCE - PARALYSIS OF AN ARM OR LEG - LOSS OF SENSATION IN A BODY PART |
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What is Body Dysmorphic Disorder?
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Preoccupation with an imagined defect in appearance, causing distress or interfering with social, occupational, or other important areas of functioning
* Mostly occurs in Caucasians |
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Interventions for somatoform disorders
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- teach stress management and relaxation techniques
- examine one's own attitudes toward somatoform disorders and how these attitudes can effect client interactions |
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What is Dissociative Amnesia?
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- An inability to recall important personal information , usually of traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness
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What is Dissociative Amnesia usually associated with?
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- overwhelming stress!
- which may be generated by traumatic life events, accidents, or disasters that are experienced or witnessed |
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What is Dissociative Identity Disorder (DID) characterized by?
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- Characterized by 2 or more identities
- Or personalities that alternatively take over the person's behavior |
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What is DID also known as?
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MULTIPLE PERSONALITY DISORDER
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Patients that have DID may have amnesia involving what?
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- May have Amnesia involving inability to recall important personal information relating to some of the identities
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DID is associated with a high incidence of?
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SUICIDE ATTEMPTS
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Name symptoms of DID
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* Most clients have symptoms of other comorbid conditions including:
- DEPRESSION - AMNESIA - SEVERE HEADACHES OR OTHER BODILY PAIN - time distortions , time relapse - ANXIETY - PHOBIAS - PANIC ATTACKS - SEXUAL DYSFUNCTION - EATING DISORDERS - SUICIDAL PREOCCUPATION - may experience depersonalization - may experience derealization - SELF MUTILATION - POST TRAUMATIC STRESS SYNDROME |
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The client hears what in DID?
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They hear:
- INNER VOICES - Voices of other personalities , which often comment or address the client |
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What kinds of level of functions do patients have with DID?
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FLUCTATING LEVELS OF FUNCTION
* from highly effective to disabled |
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What is Depersonalization?
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feeling unreal as if observing self from outside
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What is Derealization?
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Experiencing familiar persons and surroundings as if they were unfamiliar and strange or unreal
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What is treatment for DID?
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- individual psychotherapy
- hypnosis - cognitive-behavioral therapy enabling a client to deal with stress - keep a log of emotions to analyze them rationally - help client develop a crisis plan |
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When DID (personality integration) is impossible or undesirable by client , treatment aims at?
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SYMPTOM REDUCTION
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What is labile?
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mood fluctuates
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Personality disorders are what?
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- pervasive
- maladaptive - inflexible |
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What is splitting?
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flip from good to bad
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In personality disorder , enduring a pattern of inner experience and behavior includes?
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- deviates markedly from the expectation of one's culture
- is pervasive , maladaptive and inflexible - has onset of adolescence or early adulthood - is stable over time - leads to distress or impairment |
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Personality disorders share 4 common characteristics like?
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- Inflexible / maladaptive
- disability in social / professional relationships - Tendency to provoke interpersonal conflict - capacity to cause irritation or stress to others |
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People with personality disorders are known to do what?
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- change friends and jobs
- have an unsteady identity |
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Personality disorders are predisposing factors for many other psychiatric disorders and often co-occur with what?
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DEPRESSION AND ANXIETY
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Name cluster B types of personality disorders
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- ANTI-SOCIAL PERSONALITY
- BORDERLINE PERSONALITY |
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What is antisocial personality?
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- disregard for others with exploitation , lack of empathy
- repeated unlawful actions -deceit - SEXUAL ACTING OUT - failure to accept personal responsibility - MALDADAPTIVE COPING - low tolerance for frustration - VIOLENCE |
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Is there really a cure for antisocial personality?
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- NO CURE
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Antisocial personality occurs from?
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- severe abuse
- as a child enjoyed hurting animals - common in men |
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If have anti-social personality prior to being 18 years old , what is it called?
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CONDUCT DISORDER
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What is borderline personality?
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- Instability of Affect , identity and relationships
- LACK OF SELF-ESTEEM - FEAR OF ABANDONMENT -Strong dependency needs - splitting behaviors - manipulation - impulsiveness - OFTEN TRIES SELF MUTILATION AND MAY BE SUICIDAL |
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What is Dependent personality?
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- EXTREME DEPENDENCY in close relationship with urgent search to find a replacement when 1 relationship ends
- INDECESIVE |
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what cluster is dependent personality in?
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CLUSTER C
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What is most frequently seen personality disorder?
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DEPENDENT PERSONALITY
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Nursing intervention for Dependent personality?
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- can help put info in front of them , but do not make decision for them
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What is splitting?
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- the inability to incorporate positive and negative aspects of self into a whole image
- commonly associated with borderline personality |
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What is cognitive theory?
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excessive anxiety is caused by distorted thinking that is amendable to correction
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Psychoanalytic theory focuses on?
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USE OF PRIMITIVE DEFENSE MECHANISMS
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Environmental factors include
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- specific parenting styles are causative factors in different personality disorders
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Nursing interventions for personality disorders
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- safety is the priority concern
- developing a therapeutic relationship is often challenging due to client distrust or hostility - Use a firm, yet supportive approach and consistent care to help build the therapeutic relationship - SET LIMITS WHEN WORKING WITH CLIENT who is manipulative or acts out - offer realistic choices to enhance sense of control |
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Why do client with personality disorders act out?
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- They may feel threatened or feel loss of control
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What should you do if patient with personality disorder feels powerless?
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- give them a sense of freedom of choice , while still setting boundaries
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Communication strategies for personality disorders?
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- set limits and be consistent (for borderline and antisocial personalities)
- explain consequences of behavior - use assertiveness training and modeling ( for dependent personality) |
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Basic level interventions for personality disorders
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- MILIEU THERAPY
- PSYCHOBIOLOGICAL INTERVENTIONS - DIALECTICAL BEHAVIOR THERAPY |
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What is Milieu therapy aimed at in personality disorders?
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- aimed at affect of management in group context
- includes coping skills groups - psycho-educational groups - socializing groups |
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What kind of agents does Psychobiological interventions have?
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- PSYCHOTROPIC AGENTS
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What is Dialectical behavior therapy?
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- type of cognitive behavioral therapy used for clients with borderline personality disorder
- focuses on gradual behavior changes and provides acceptance and validation |
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What is Anorexia Nervosa characterized by?
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- Preoccupation with food and the rituals of eating , along with voluntary refusal to eat
- A morbid fear of obesity and a refusal to maintain minimally normal body weight in absence of a physical ( < 85 % of normal) |
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What are the names of the two types of anorexia?
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1) restricting
2) binge-purge type |
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Who does anorexia occur most in?
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- In females from adolescence to young adulthood
- in females accompanied by amenorrhea for at least 3 consecutive cycles |
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What could be cause of anorexia?
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- due to childhood or control issues
* chronic condition that follows person throughout life |
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Common lab findings of Anorexia
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- Hypokalemia
- Anemia and leukopenia - ELEVATED LIVER ENZYMES - possible elevated cholesterol - abnormal thyroid function tests - ELEVATED CAROTENE (causes yellow skin) - Decreased bone density |
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What is Bulimia Nervosa characterized by?
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- By recurrent episodes of eating large quantities of food over a short period of time (BINGING)
- May be followed by inappropriate compensatory behaviors to rid the body of excessive calories such as induced vomiting (PURGING) |
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What are the two types of Bulimia?
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1) Purging
2) Non-purging |
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Do most clients maintain normal weight in Bulimia?
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- yes or even slightly higher
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What is the average onset of Bulimia in females and males?
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- females: 15-18 years
- 10-15 % are males with onset of 18-26 yr old |
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Common lab findings of Bulimia nervosa
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- Hypokalemia
- Hypernatremia - Hypochloremia |
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The type and extent of electrolyte imbalance may depend on what in Bulimia?
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- depends on method used when purging such as:
- vomiting - laxative use - diuretic use |
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What the risk factors of eating disorders?
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- Family genetics = history with eating disorders
- Biological - Interpersonal relationships - Psychological influences - Environmental factors = pressure from society to have perfect body - family eating patterns & individual history of picky eater - participation in athletics (especially elite level) |
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Define risk factors:
- Biological - Interpersonal relationships - psychological influences |
- Biological = hypothalamic , hormonal neurotransmitter or biochemical imbalance or disturbances of serotonin neurotransmitter pathway may be implicated
- Interpersonal relationships: influenced by parental pressure & need to succeed - psychological influences: rigidity , ritualism, separation and individuation conflicts; feelings of ineffectiveness , helplessness , distorted body image and depression |
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Males and Eating disorders
- males account for how much in anorexia and bulimia? - risk factors? |
- 5 to 10 % of anorexia
- 10 to 15 % in bulimia - risk factors: dieting , sports , history of obesity |
